Family and Social Services Administration

Indiana Home and Community-Based Services Waivers

This program allows Indiana Medicaid programs to pay for services that are provided in a person’s home or other community setting rather than a Medicaid funded facility or institution. Persons must qualify for institutional care in order to be eligible for home and community-based services. Waiver refers to the waiving of certain federal requirements that otherwise apply to Medicaid program services. The Division of Aging oversees two waivers; they are the Aged and Disabled Waiver (A&D) and the Traumatic Brain Injury Waiver (TBI).

Aged and Disabled Waiver (A&D)

The A&D Waiver provides an alternative to nursing facility admission for adults and persons of all ages with a disability. The waiver is designed to provide services to supplement informal supports for people who would require care in a nursing facility if waiver or other supports were not available. Waiver services can be used to help people remain in their own homes, as well as assist people living in nursing facilities to return to community settings such as their own homes, apartments, assisted living or Adult Family Care.

Adult Day Services (ADS) - Adult Day Services are community-based group programs designed to meet the needs of adults with impairments through individual plans of care. These structured, comprehensive, non-residential programs provide health, social, recreational, and therapeutic activities, as well as supervision, support services, and personal care. These services must be provided in a congregate, protective setting and meals and/or nutritious snacks are required.

Adult Family Care (AFC) Adult Family Care is a comprehensive service in which the participant of services resides with an unrelated caregiver in order for the participant to receive personal assistance designed to provide options for alternative long term care to individuals who meet nursing facility level of care and whose needs can be met in a home-like environment. The participant and up to three(3) other participants who are elderly or have physical and/or cognitive disabilities who are not members of the provider's or primary caregiver's family, reside in a home that is owned, rented, or managed by the Adult Family Care provider. Participants selecting the AFC service may also receive Case Management Services, Adult Day Services, Specialized Medical Equipment and Supplies and Health Care Coordination through the waiver. TBI participants may also receive: Behavior Management, Structured Day Program, Individual and Group and Supported Employment.

Assisted Living (AL) – Assisted Living Service is defined as personal care, homemaker, chore, attendant care and companion services, medication oversight (to the extent permitted under State law), therapeutic social and recreational programming, provided in a home-like environment in a residential facility which is licensed by the Indiana State Department of Health, in conjunction with residing in the facility. This service includes 24 hour on-site response staff to meet scheduled or unpredictable needs in a way that promotes maximum dignity and independence, and to provide supervision, safety and security. Participants may also receive Case Management Services, Specialized Medical Equipment and Supplies and Health Care Coordination through the waiver.

Attendant Care (ATTC) - Attendant Care services primarily involve hands-on assistance for aging adults and persons with disabilities. These services are provided in order to allow older adults or persons with disabilities to remain in their own homes and to carry out functions of daily living, self-care, and mobility.

Case Management - Case Management is a comprehensive service comprised of a variety of specific tasks and activities designed to coordinate and integrate all other services required in the individual’s care plan. Case Management is required in conjunction with the provision of any home and community-based service.

Community Transition Services - Community Transition Services include reasonable, set-up expenses for individuals who make the transition from an institution to their own home where the person is directly responsible for his or her own living expenses in the community and will not be reimbursable on any subsequent move. Reimbursement is limited to a lifetime cap for set up expenses up to $1,500.

Environmental Modifications - Environmental Modifications are minor physical adaptations to the home, as required by the individual’s Plan of Care/Cost Comparison Budget. The modifications must be necessary to ensure the health, welfare and safety of the individual and enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. Maintenance is limited to $500 annually for the repair and service of environmental modifications that have been provided through the waiver. There is also a lifetime cap of $15,000.

**Environmental Modification Assessment is a service which determines the scope and specifications for environmental modifications necessary to enable an individual to function with greater independence within their home, and without which they would require institutionalization. The Assessor reviews the feasibility and writes the specifications which serve as the criteria for obtaining and evaluating bids. Upon completion of the work the Assessor conducts a post-project inspection to assure project completion.

Health Care Coordination - Health Care Coordination includes medical coordination provided by a Registered Nurse to manage the health care of the individual including physician consults, medication ordering, and development and nursing oversight of a healthcare support plan. Skilled nursing services are provided within the scope of the Indiana State Nurse Practice Act. The purpose of Health Care Coordination is stabilization; prevention of deteriorating health; management of chronic conditions; and/or improved health status.

Homemaker - Homemaker services offer direct and practical assistance consisting of household tasks and related activities. The services assist the individual to remain in a clean, safe, healthy home environment and are provided when the individual is unable to meet these needs or when an informal caregiver is unable to meet these needs for the individual.

Home Delivered Meals – Home Delivered Meals are nutritionally balanced meals that help prevent institutionalization because the absence of nutrition in individuals with frail and disabling conditions presents a severe risk to health. No more than two meals per day will be reimbursed under the waiver.

Nutritional Supplements – Nutritional Supplements include liquid supplements, such as “Boost” or “Ensure” to maintain an individual’s health in order to remain in the community. Supplements should be ordered by a physician based on specific life stage, gender, and/ or lifestyle. There is an annual cap of $1,200.

Personal Emergency Response Systems (PERS) - Personal Emergency Response Systems (PERS) are electronic devices which enable certain individuals at high risk of institutionalization to secure help in an emergency. The individual may also wear a portable help button to allow for mobility. The system is connected to the person’s phone and programmed to signal a response center once a “help” button is activated. The response center is staffed 24 hours daily/ 7 days per week by trained professionals.

Pest Control - Pest Control services are designed to prevent, suppress, or eradicate anything that competes with humans for food and water, injures humans, spreads disease and/or annoys humans and is causing or is expected to cause more harm than is reasonable to accept. Pests include insects such as roaches, mosquitoes, and fleas; insect-like organisms, such as mites and ticks; and vertebrates, such as rats and mice. There is an annual cap of $600.

Respite - Respite services are those services that are provided temporarily or periodically in the absence of the usual caregiver. Service may be provided in an individual’s home; the private home of the caregiver, or in a Medicaid certified nursing facility. For those individuals receiving the service of Adult Family Care, funding for respite is already included in the per diem amount and the actual service of respite may not be billed. The level of professional care provided under respite services depends on the needs of the individual. An individual requiring assistance with bathing, meal preparation and planning, specialized feeding, such as an individual who has difficulty swallowing, refuses to eat, or does not eat enough; dressing or undressing; hair and oral care; and weight bearing transfer assistance should be considered for respite home health aide under the supervision of a registered nurse. An individual requiring infusion therapy; venipuncture; injection; wound care for surgical, decubitus, incision, ostomy care; and tube feedings should be considered for respite nursing services (RNUR).

Specialized Medical Equipment & Supplies - Specialized Medical Equipment and Supplies are medically prescribed items required by the individual’s Plan of Care/Cost Comparison Budget, which are necessary to assure the health, welfare and safety of the individual, which enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. Individuals requesting authorization for this service through the waiver must first exhaust eligibility of the equipment or supplies through the Indiana Medicaid State Plan. There should be no duplication of services. Maintenance is limited to $500 annually for the repair and service of items that have been provided though the waiver.

**Structured Family Caregiving is a service through which a participant receives care in their own home or the home of a principal caregiver. The principal caregiver cannot be the participant’s spouse, the parent of a participant who is a minor, or the legal guardian of the participant. Only agencies may offer Structured Family Caregiving. All Structured Family Caregiving settings must be approved and supervised by the provider agency and all paid caregivers are trained and paid by the provider.

Transportation –Transportation Services enable individuals served under the waiver to gain access to waiver and other community services, activities and resources, specified by the plan of care. Transportation services under the waiver shall be offered in accordance with an individual’s plan of care and whenever possible, family, neighbors, friends, or community agencies which can provide this service without charge will be utilized. This service is offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the State plan, if applicable, and shall not replace them.

Vehicle Modifications - Vehicle Modifications are the addition of adaptive equipment or structural changes to a motor vehicle that permit an individual with a disability to be safely transported in a motor vehicle. Vehicle modifications, as specified in the Plan of Care/Cost Comparison Budget, may be authorized when necessary to increase an individual’s ability to function in a home and community based setting to ensure accessibility of the individual with mobility impairments. These services must be necessary to prevent or delay institutionalization. The necessity of such items must be documented in the plan of care by a physician’s order. Vehicles necessary for an individual to attend post secondary education or job related services should be referred to Vocational Rehabilitation Services. Maintenance is limited to $500 annually for repair and services of items that have been funded though the waiver and there is a $15,000 lifetime cap

Traumatic Brain Injury Waiver (TBI)

The TBI Waiver provides home and community-based services to individuals who, but for the provision of such services, would require institutional care. Through the use of the Traumatic Brain Injury Waiver (TBI), the Indiana Office of Medicaid Policy and Planning and the Indiana Division of Aging seek to increase availability and access to cost-effective traumatic brain injury waiver services to people who have suffered a traumatic brain injury. Indiana defines a traumatic brain injury as a trauma that has occurred as a closed or open head injury by an external event that results in damage to brain tissue, with or without injury to other body organs. Examples of external agents are: mechanical; or events that result in interference with vital functions. Traumatic brain injury means a sudden insult or damage to brain function, not of a degenerative or congenital nature. The insult of damage may produce an altered state of consciousness and may result in a decrease in cognitive, behavioral, emotional, or physical functioning resulting in partial or total disability not including birth trauma related injury.

Adult Day Services (ADS) - Adult Day Services are community-based group programs designed to meet the needs of adults with impairments through individual plans of care. These structured, comprehensive, non-residential programs provide health, social, recreational, and therapeutic activities, as well as supervision, support services, and personal care. These services must be provided in a congregate, protective setting. Meals and/or nutritious snacks are required.

Adult Family Care (AFC) - Adult Family Care is a comprehensive service in which the participant of services resides with an unrelated caregiver in order for the participant to receive personal assistance designed to provide options for alternative long term care to individuals who meet nursing facility level of care and whose needs can be met in a home-like environment. The participant and up to three (3) other participants who are elderly or have physical and/or cognitive disabilities who are not members of the provider’s or primary caregiver’s family, reside in a home that is owned, rented, or managed by the Adult Family Care provider. Participants selecting the AFC service may also receive Case Management Services, Adult Day Services, Specialized Medical Equipment and Supplies and Health Care Coordination through the waiver.

Assisted Living (AL) – Assisted Living Service is defined as personal care, homemaker, chore, attendant care and companion services, medication oversight (to the extent permitted under State law), therapeutic social and recreational programming, provided in a home-like environment in a residential facility which is licensed by the Indiana State Department of Health, in conjunction with residing in the facility. This service includes 24 hour on-site response staff to meet scheduled or unpredictable needs in a way that promotes maximum dignity and independence, and to provide supervision, safety and security. Participants may also receive Case Management Services, Specialized Medical Equipment and Supplies and Health Care Coordination through the waiver.

Attendant Care Service - Attendant Care Services primarily involve hands-on assistance for older adults and persons with disabilities who have physical needs. These services are provided in order to allow older adults or persons with disabilities to remain in their own homes and to carry out functions of daily living, self-care, and mobility.

*Behavior Management/ Behavior Program and Counseling - Behavior Management includes training, supervision, or assistance in appropriate expression of emotions and desires, assertiveness, acquisition of socially appropriate behaviors, and the reduction of inappropriate behaviors.

Case Management - Case Management is a comprehensive service comprised of a variety of specific tasks and activities designed to coordinate and integrate all other services required in the individual’s care plan. Case Management is required in conjunction with the provision of any home and community-based service.

Community Transition Services - Community Transition Services include reasonable, set-up expenses for individuals who make the transition from an institution to their own home where the person is directly responsible for his or her own living expenses in the community and will not be reimbursable on any subsequent move. Reimbursement is limited to a lifetime cap for set up expenses up to $1,500.

Environmental Modifications – Environmental Modifications are physical adaptations to the home, required by the individual’s plan of care, which are necessary to ensure the health, welfare and safety of the individual, or enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. Maintenance is limited to $500 annually for the repair and service of environmental modifications that have been provided through the waiver. There is also a life time cap of $15,000.

Health Care Coordination - Health Care Coordination includes medical coordination provided by a Registered Nurse to manage the health care of the individual including physician consults, medication ordering, and development and nursing oversight of a healthcare support plan. Skilled nursing services are provided within the scope of the Indiana State Nurse Practice Act. The purpose of Health Care Coordination is stabilization; prevention of deteriorating health; management of chronic conditions; and/or improved health status.

Homemaker - Homemaker Services offer direct and practical assistance consisting of household tasks and related activities. These services assists the individual to remain in a clean, safe, healthy home environment and are provided when the individual is unable to meet these needs or when an informal caregiver is unable to meet these needs for the individual.

Home Delivered Meals – Home Delivered Meals are nutritionally balanced meals that help prevent institutionalization because the absence of nutrition in individuals with frail and disabling conditions presents a severe risk to health. No more than two meals per day will be reimbursed under the waiver.

Nutritional Supplements – Nutritional Supplements include liquid supplements, such as “Boost” or “Ensure” to maintain an individual’s health in order to remain in the community. Supplements should be ordered by a physician based on specific life stage, gender, and/ or lifestyle. There is an annual cap of $1,200.

Personal Emergency Response Systems (PERS) – Personal Emergency Response Systems (PERS) are electronic devices which enable certain individuals at high risk of institutionalization to secure help in an emergency. The individual may also wear a portable help button to allow for mobility. The system is connected to the person’s phone and programmed to signal a response center once a “help” button is activated. The response center is staffed 24 hours daily/ 7 days per week by trained professionals.

Pest Control - Pest Control services are designed to prevent, suppress, or eradicate anything that competes with humans for food and water, injures humans, spreads disease and/or annoys humans and is causing or is expected to cause more harm than is reasonable to accept. Pests include insects such as roaches, mosquitoes, and fleas; insect-like organisms, such as mites and ticks; and vertebrates, such as rats and mice. There is an annual cap of $600.

*Residential Based Habilitation - Residential Based Habilitation Service provides training to regain skills that were los secondary to the traumatic brain injury.

Respite Care - Respite Care services are those services that are provided temporarily or periodically in the absence of the usual caregiver. Service may be provided in an individual’s home, in the private home of the caregiver, or in a Medicaid certified nursing facility. For those individuals receiving the service of Adult Family Care, funding for respite is already included in the per diem amount and the actual service of respite may not be billed. The level of professional care provided under respite services depends on the needs of the individual. An individual requiring assistance with bathing, meal preparation and planning, specialized feeding, such as an individual who has difficulty swallowing, refuses to eat, or does not eat enough; dressing or undressing; hair and oral care; and weight bearing transfer assistance should be considered for respite home health aide under the supervision of a registered nurse. An individual requiring infusion therapy; venipuncture; injection; wound care for surgical, decubitus, incision, ostomy care; and tube feedings should be considered for respite nursing services.

Specialized Medical Equipment & Supplies - Specialized Medical Equipment and Supplies include devices, controls, or appliances, specified in the plan of care, which enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live and without which the individual would require institutionalization. Individuals requesting authorization for this service through the waiver must first exhaust eligibility of the equipment or supplies through the Indiana Medicaid State Plan. There should be no duplication of services. Maintenance is limited to $500 annually for the repair and service of items that have been provided though the waiver.

*Structured Day Program – Structured Day Program is assistance with acquisition, retention, or improvement in self-help, socialization and adaptive skills, which takes place in a non-residential setting, separate from the home in which the individual resides. The services are normally furnished four (4) or more hours per day on a regularly scheduled basis, for one (1) or more days per week unless provided as an adjunct to other day activities included in an individual’s plan of care.

*Supported Employment - Supported Employment Services consist of paid employment for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting. Supported Employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. The service includes activities needed to sustain paid work by individuals receiving waiver services, including supervision and training.

Transportation - Transportation Services enable individuals served under the waiver to gain access to waiver and other community services, activities and resources, specified by the plan of care. Transportation services under the waiver shall be offered in accordance with an individual’s plan of care and whenever possible, family, neighbors, friends, or community agencies which can provide this service without charge will be utilized. This service is offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the State plan, if applicable and shall not replace them.

Vehicle Modifications - Vehicle Modifications are the addition of adaptive equipment or structural changes to a motor vehicle that permit an individual with a disability to be safely transported in a motor vehicle. Vehicle modifications, as specified in the Plan of Care/Cost Comparison Budget, may be authorized when necessary to increase an individual’s ability to function in a home and community based setting to ensure accessibility of the individual with mobility impairments. These services must be necessary to prevent or delay institutionalization. The necessity of such items must be documented in the plan of care by a physician’s order. Vehicles necessary for an individual to attend post secondary education or job related services should be referred to Vocational Rehabilitation Services. Maintenance is limited to $500 annually for repair and services of items that have been funded though the waiver and there is a $15,000 lifetime cap.

*Traumatic Brain Injury Services Only

WHERE TO BEGIN TO BECOME AN HCBS WAIVER PROVIDER

After reviewing the information provided above you will need to complete an application for certification. A table indicating required documents for each waiver service is available for you to review. Any additional questions or inquiries may be submitted to the Waiver Provider Specialist by phone at 317-232-4650 or by email at daproviderapp@fssa.in.gov.

Once all documentation and forms are received by the Division of Aging, the Waiver Provider Analyst will review your Provider Application packet. There may be some follow-up questions or additional information needed. You may be contacted via email or telephone. It is important that you reply as soon possible in order to avoid any unnecessary delays in processing your application. If the necessary documentation is not submitted in a timely manner, the application may be returned to you with the request to resubmit.

If you are applying to be an Adult Family Care provider, Assisted Living provider, or an Adult Day Services Provider, you will also need to have an onsite survey conducted by the Division of Aging.

Upon completion of the application process through the Division of Aging, you will be notified by mail that your certification has been approved or denied. Information regarding the appeal process will also be included, in the event your application is denied.

If approved, you will then be directed to download your Indiana Health Coverage Programs Waiver Billing Provider Application and Profile Maintenance packet through HP. (See HCBS waiver manual, Section 1. Helpful hints are also included). You will be notified by letter when the process is complete and your waiver billing number is assigned.

NOTE: YOU MUST SUBMIT YOUR APPLICATION TO HP WITHIN 90 DAYS OF RECEIPT OF YOUR WAIVER PROVIDER CERTIFICATION FROM THE DIVISION OF AGING

You may begin providing services when you receive you HP billing number, are activated in the waiver provider database and receive your Notice of Action.

Money Follows the Person

The Money Follows the Person (MFP) program is a demonstration grant funded by the Centers for Medicare and Medicaid and is available through 2020. The MFP provides services and supports which may assist individuals, living in qualified institutions, in returning to the community to live as independently as possible. Applicants who enroll as waiver service providers may also be enrolled in the MFP program.

Once you become a waiver provider, you will need to keep the provider relations specialist aware of any changes to your status. This includes legal and /or DBA name changes. Additional forms will need to be completed as well as subsequent updates through HP. Be sure to contract the Waiver Provider Analyst (317-232-4650) within 10 days of the change to your name.